August

Eating disorders are associated with fertility problems, unplanned pregnancies and negative attitudes to pregnancy, finds new research from the Institute of Psychiatry at King’s College London and UCL, published today in BJOG: An International Journal of Obstetrics and Gynaecology.

Women with lifetime anorexia and bulimia were investigated against a general population of women to assess the impact of their eating disorder.

The study looked at 11,088 women from the Avon Longitudinal Study of Parents and Children (ALSPAC). Women were asked to complete questionnaires at 12 and 18 weeks gestation.

Of the total number of women, 171 (1.5%) had anorexia at some point in their life, 199 (1.8%) had bulimia and an additional 82 (0.7%) had suffered from both conditions. The remaining 10,636 (96%) formed the general population comparison group.

Women with a history of anorexia and bulimia took longer than six months to conceive (39.5%) compared to the general population (25%). However, they were no more likely to take longer than 12 months to conceive than the general population.

The study found that women with anorexia and bulimia were more than twice as likely (6.2%) than the general population (2.7%) to have received treatment or help to conceive their current pregnancy.

However, when asked at 18 weeks gestation, women with anorexia were more likely to report that their current pregnancy was unintentional. In this group of women 41.5% said their pregnancy was unplanned compared to 28.6% of women in the general population.

In addition, at 18 weeks gestation all participants were asked how they felt when they discovered that they were pregnant and how they currently felt about their pregnancy. The majority of women reported feeling overjoyed/pleased when they discovered that they were pregnant (71%). However, eating disorders were linked to negative feelings about pregnancy.

In women with anorexia and bulimia negative feelings remained stronger at 18 weeks gestation. Furthermore, women with lifetime anorexia more frequently viewed motherhood as a personal sacrifice.

Lead author, Abigail Easter at the Institute of Psychiatry, says: 'This research highlights that there are risks to fertility associated with eating disorders. However, the high rates of unplanned pregnancies in women with a history of anorexia suggest that women may be underestimating their chances of conceiving.

'Pregnancy can be a difficult time for women with eating disorders and this is the first time feelings about pregnancy have been looked at amongst this group of women.

'Women planning a pregnancy should ideally seek treatment for their eating disorder symptoms prior to conception and health professionals should be aware of eating disorders when assessing fertility and providing treatment for this.'

Dr Nadia Micali, lead investigator at the Institute of Child Health at UCL adds: 'Health professionals are often unaware of the effects of eating disorders on pregnancy and fertility. Women with a history of anorexia for example are more likely to have unplanned pregnancies. This has now been replicated in three large studies and has important repercussions on the level of antenatal and postnatal care they will need.'

Professor Philip Steer, BJOG editor-in-chief says: 'This research looks at how women with eating disorders are feeling when they are pregnant which has important clinical consequences. They will require more support during the antenatal and postnatal period.'

The research was funded by the ARIADNE programme (Applied Research into Anorexia Nervosa and Not Otherwise Specified Eating Disorders) which is funded by the Department of Health National Institute of Health Research (NIHR) Programme Grant for Applied Research. The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for the ALSPAC study.

The researchers are extremely grateful to all the families who took part in this study, the midwives who helped recruit them, and the whole ALSPAC team.